Since the begining of modern anesthesia, in 1846 the anesthestist has relied on his natural senses to monitor the patient aided recently by simple technical devices such as stethoscope .The modern technology has provided a large number of sophisticated monitors most of these techniques have enhance our understanding of the mechanism of patient decompensation and have helped us to guide appropriate therapeutic interventions. Appropriate hemodynamic monitoring and assessment are fundamental keys to improve patient safety by goal directed hemodynamic management. One of the basic problems that we frequently face is the lack of hemodynamic monitoring